Darunavir effective across range of treatment-experienced HIV patients,
research suggests
Darunavir should be considered as a treatment option in lopinavir-naive, treatment-experienced patients with HIV, according to research published
in The Lancet (2007;370:49).
Launched earlier this year (PJ, 10 March, p273), protease
inhibitor darunavir (Prezista), in combination with ritonavir, has been shown to be effective
in highly treatment-experienced patients but has not been assessed in
patients with less advanced disease who have been treated less vigorously.
In this study, 595 patients were randomised to receive darunavir/ritonavir
or lopinavir/ritonavir twice daily. Of these, 31 per cent were protease
inhibitor-naive and 82 per cent were susceptible to four or more protease
inhibitors.
At week 48, more darunavir/ritonavir than lopinavir/ritonavir patients
had HIV RNA of less than 400 copies per ml (77 per cent versus 67 per
cent; estimated difference 10 per cent, 95 per cent confidence interval
2–17; P<0.0001). Reported adverse events were similar
in the two groups.
The researchers also found that darunavir/ritonavir was associated with
a lower incidence of treatment failure and a lower emergence of mutations
than was lopinavir/ritonavir. They
say that, in view of this, darunavir/ritonavir provides highly effective
therapy across the range of treatment-experienced patients.
However, the author of an accompanying editorial (ibid, p3) comments
that the results will probably not result in a large-scale switch from
lopinavir to darunavir. “First, darunavir’s superior efficacy
may be difficult to show in drug-naive patients, in whom pre-existing
resistance to lopinavir is not a rule. Second, darunavir/ritonavir is
more expensive, particularly in the US, than lopinavir/ritonavir.”
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